부산대학교 도서관

A 32-year-old man was seen at our hospital because of severe upper abdominal pain and diarrhea. He had no past history of laparotomy. Plain X-ray of the abdomen showed multiple air fluid levels in the dilated small intestine and he was admitted with a diagnosis of acute enterocolitis and ileus. In spite of conservative treatment by a long tube, bowel obstruction did not improve. Contrast enhanced CT scan of the abdomen performed again showed a “whirl like pattern”. We diagnosed the case as small intestinal volvulus and conducted emergency operation 34 hours after hospitalization. The small intestine was twisted counterclockwise by 360° at the root of the superior mesenteric artery. Because there were no adhesion, tumors and anatomical abnormalities, primary volvulus of the small intestine was diagnosed. There was no necrosis in the small intestine, and only untwisting of axis rotations was thus performed.To the best of our knowledge, only 41 cases of primary small intestinal volvulus without past history of laparotomy, including our case, have been reported in Japan. Contrast enhanced abdominal CT scan performed again was useful in making early diagnosis in this case.